Effect of Antibiotic Therapy on the Density of Vancomycin-Resistant Enterococci in the Stool of Colonized Patients

Donskey, Curtis J.; Chowdhry, Tanvir K.; Hecker, Michelle; Hoyen, Claudia K.; Hanrahan, Jennifer; Hujer, Andrea M.; Hutton-Thomas, Rebecca; Whalen, Christopher C.; Bonomo, Robert A.; Rice, Louis B.

doi:10.1056/nejm200012283432604

Cited by 622 publications

(513 citation statements)

References 35 publications

(8 reference statements)

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“…22 On one hand, the use of anaerobic coverage (pip-tazo) has been associated with increased incidence of VRE colonization after its use, during the period of recovery of the original gut microflora. [23][24][25] On the other hand, a previous study by Bradley et al 22 found a decreased incidence of VRE while cycling ceftazidime and pip-tazo. A sample of VRE isolates collected from our hematologyoncology unit during our study period was found to be primarily clonal by pulsed-field gel electrophoresis analysis (data not shown).…”

Section: Discussionmentioning

confidence: 93%

Antibiotic cycling to decrease bacterial antibiotic resistance: a 5-year experience on a bone marrow transplant unit

Cadena

Taboada

Burgess

et al. 2007

Bone Marrow Transplant

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Section: Discussionmentioning

confidence: 93%

Antibiotic cycling to decrease bacterial antibiotic resistance: a 5-year experience on a bone marrow transplant unit

Cadena

Taboada

Burgess

et al. 2007

Bone Marrow Transplant

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“…23 Investigators found that anti-anaerobic antibiotics appeared to promote high-density VRE colonization that in turn was associated with a higher likelihood of VRE transmission. Thus, antibiotics used to prevent a first infection may inadvertently lead to development of a second and even more serious condition.…”

Section: Unexpected Pathogensmentioning

confidence: 99%

Antibiotic prophylaxis in patients receiving hematopoietic stem cell transplant

Sepkowitz

2002

Bone Marrow Transplant

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Summary:Effective prophylaxis against specific infections has allowed increasingly potent conditioning regimens to be given, thereby prolonging survival in HSCT recipients. The Centers for Disease Control and Prevention, in collaboration with numerous professional societies, has recently published guidelines to codify and advance this approach. Controversy remains in several areas but, curiously, the most intense debate concerns prevention of bacterial infections, the most extensively studied of all of the approaches. Central to this debate are the competing priorities of a potentially ill patient on the one hand vs the long-term consequences of unchecked antibiotic use. The emergence in the 1990s of vancomycin-resistant Enterococcus demonstrated all too vividly how devastating such an end result could be. This article will review the arguments for and against the routine use of antibacterial prophylaxis in HSCT recipients.

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“…There are a large number of studies showing the impact of antibiotic use on the prevalence of VRE [19][20][21][22] . The majority of these reports show the previous use of antibiotics, e.g., vancomycin, carbapenem, metronidazole, clindamycin, and cephalosporin, as independent risk factor for the acquisition of VRE.…”

Section: Resultsmentioning

confidence: 99%

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

Rossini

Fagnani

Leichsenring

et al. 2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.

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Effect of Antibiotic Therapy on the Density of Vancomycin-Resistant Enterococci in the Stool of Colonized Patients

Abstract: For patients with vancomycin-resistant enterococci in stool, treatment with antianaerobic antibiotics promotes high-density colonization. Limiting the use of such agents in these patients may help decrease the spread of vancomycin-resistant enterococci.

Cited by 622 publications

References 35 publications

Antibiotic cycling to decrease bacterial antibiotic resistance: a 5-year experience on a bone marrow transplant unit

Antibiotic cycling to decrease bacterial antibiotic resistance: a 5-year experience on a bone marrow transplant unit

Antibiotic prophylaxis in patients receiving hematopoietic stem cell transplant

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

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